A Randomized Comparison of Nitrous Oxide Plus Hematoma Block Versus Ketamine Plus Midazolam for Emergency Department Forearm Fracture Reduction in Children

Luhmann, Jan D.; Schootman, Mario; Luhmann, Scott J.; Kennedy, Robert M.

doi:10.1542/peds.2005-1694

Cited by 79 publications

(47 citation statements)

References 41 publications

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“…16 Dezfuli et al has described maximum recommended doses of both lignocaine as well as bupivacaine for HB. 17 Researchers have used varied concentrations of 1-10% lignocaine and even prilocaine 6,8,9,18 ; however, all studies have used a fixed volume dose. There is a potential concern related to use of combination of LA and their total dose.…”

Section: Discussionmentioning

confidence: 99%

“…Occurrences of LA toxicity following HB are unlikely and this fact has been supported by several studies. 6,9,[19][20][21] Here, it is pertinent to mention that the fracture haematoma behaves as a closed …”

Section: Discussionmentioning

confidence: 99%

“…HB has been shown to provide safe and effective analgesia for manipulation of forearm and wrist fractures in adults. [6][7][8][9] A Cochrane review in 2002 concluded that HB is much safer and can be done easily in emergency department. 14 The HB is easily performed even by a non-anaesthetist and can be used effectively in a district hospital which lacks advanced anaesthesia and intensive care facilities.…”

Section: Discussionmentioning

confidence: 99%

“…Both the techniques have been studied independently and also compared with other techniques such as sedation, brachial plexus block, etc. [8][9][10] However, there is no study in the literature till date which has combined these two techniques. HB and IVRA together are also an attractive option since they do not require expertise or equipments such as ultrasound or peripheral nerve stimulator needed for brachial plexus block and hazards of GA are obviated.…”

Section: Introductionmentioning

confidence: 99%

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Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia

Verma

Hasnain

Sreevastava

et al. 2016

Medical Journal Armed Forces India

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m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 2 ( 2 0 1 6 ) 2 4 7 -2 5Methods: An observational case series was designed with the hypothesis that a combination of HB and IVRA would overcome the aforementioned drawbacks. A standardized protocol was followed for HB with 0.1 ml/kg of 0.5% bupivacaine preceding the conduct of IVRA, which permitted adequate exsanguination of the extremity (using compression bandage). For IVRA, 0.5% lignocaine at 3 mg/kg was used with an electro-pneumatic tourniquet. Pain scores were noted after the HB, at exsanguination and during surgery.Results: 100 cases were studied. Average time of onset of block after HB was 2 min 18 s. By the time the IVRA procedure was performed, 99% of patients had a pain score of zero. The quality of surgical anaesthesia revealed that 94% of the patients did not have any pain of incision, tourniquet or positioning at any time during surgery. Conclusion:The use of dual technique of HB and IVRA improved patient acceptance and compliance, and the safety and efficacy of the IVRA. The combination anaesthesia was found to be easy to administer, effective and safe with no complications. #

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia

Verma

Hasnain

Sreevastava

et al. 2016

Medical Journal Armed Forces India

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“…4 In a recent study, staff members of the SLCH ED demonstrated the benefits of using a nitrous oxide/hematoma block for forearm fracture reduction in children. 5 In addition to the use of clinical trials, another strategy aimed at improving pain management has been the reduction or elimination of barriers to analgesic administration. This was accomplished by implementing standing orders, the first of which enabled triage nurses in the ED to administer oxycodone for suspected fractures and small burns without seeking physician approval.…”

Section: Developing Strategies For Pain Managementmentioning

confidence: 99%

On the Front Lines: Lessons Learned in Implementing Multidisciplinary Peripheral Venous Access Pain-Management Programs in Pediatric Hospitals

et al. 2008

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Venipuncture and intravenous cannulation are among the most common and widespread medical procedures performed on children today. Therefore, effective treatment of venous access pain can benefit from an integrated systems approach that enlists multiple players in the health care system. By using case studies that analyze this issue from the perspective of the nurse, the physician, the pharmacist, and the child life specialist, this article illustrates how multidisciplinary programs designed to manage needle pain have been developed successfully in several institutions. Common themes that arise from these case studies include the importance of a multidisciplinary evidence-based approach to advocate change; a system-wide protocol for the administration of local anesthetics; convenient access to topical local anesthetics; department and hospital-wide support for educational efforts, including training in nonpharmacologic techniques used by child life specialists; and ongoing quantification of the overall success of any program. Implementation of these strategies can result in significant improvements in the pediatric venous access experience. Pediatrics 2008;122:S161-S170 A TTITUDES ON PREVENTING procedural pain in children are changing as medical centers seek to comply with recent policy statements and clinical guidelines. The American Academy of Pediatrics and the American Pain Society recommend that efforts to soothe and minimize pediatric distress be considered even for minor procedures such as venipunctures. 1 A recent publication by the International Association for the Study of Pain cited humanitarian, ethical, and practical reasons for managing and preventing pediatric pain. 2 It is important to note that the management and prevention of pain in children is not limited to highly painful conditions and procedures but also includes the prevention of pain associated with venous access procedures whenever possible. 1 In this article we review the experiences of 5 children's hospitals in the United States that have well-developed peripheral venous access pain-management programs. The case studies, written by roundtable members integrally involved in the development of these programs, summarize the strategies that were used successfully in implementing systematic and multidisciplinary programs for the management of venous access pain in the individual hospitals.When the case studies are viewed in totality, a number of common strategies are found to be essential in moving the pediatric venous access pain-management programs from theory to practice: (1) assembling a multidisciplinary team to advocate change; (2) using an evidence-based approach to determine which interventions would best suit a particular institution; (3) using a system-wide protocol for the administration of local anesthetics in the hospital setting; (4) storing local anesthetics in patient care areas and using physician standing orders to facilitate access to these agents; (5) securing department and hospital-wide support of the programs ...

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Management of Painful Procedures

Bruce

2009

Managing Pain in Children

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A Randomized Comparison of Nitrous Oxide Plus Hematoma Block Versus Ketamine Plus Midazolam for Emergency Department Forearm Fracture Reduction in Children

Cited by 79 publications

References 41 publications

Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia

Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia

On the Front Lines: Lessons Learned in Implementing Multidisciplinary Peripheral Venous Access Pain-Management Programs in Pediatric Hospitals

Management of Painful Procedures

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